Questions & Answers

What is Bipolar Disorder?

Bipolar Disorder is characterized by persistent mood swings between the poles of depression and mania. These moods are greatly intensified and clearly different from the youngster's usual personality and are out of proportion to events in the youngster's life in intensity and/or in duration. Either phase can last for several days or several months. The diagnosis of Bipolar Disorder in children and adolescents is complex and entails careful observation over a period of time.

What causes Bipolar Disorder and who is likely to develop it?

Bipolar Disorder is believed to have a genetic component; a youngster with this disorder is likely to have a parent or close relative with the disorder. In addition, a family history of drug or alcohol abuse may also be associated with greater risk. The physiological basis of the disorder is supported by neuroimaging studies, and neurochemical imbalances are also involved. Although Bipolar Disorder is often diagnosed during adolescence, there is increasing belief that the signs are present, but unrecognized, earlier in life.

How would I know if my child has Bipolar Disorder?

Consulting a professional who has experience treating children with this disorder is important. With the young child the disorder is difficult to diagnose, and some experts believe that children can indeed have symptoms of grandiosity similar to those of an adult with the disorder. There are others, however, who interpret a child's mania as rapidly switching moods rather than grandiosity.

What are the symptoms of Bipolar Disorder?

The defining features of Bipolar Disorder are intense and extreme mood swings between depression and mania that cause disruption in a teen's life.

During the manic phase, the teen may experience:
• Changes in mood - the teenager may seem unusually happy or silly
• Unrealistically high self-esteem and grandiosity - for example, a teenager may feel like a superhero with special powers
• Increased energy despite a lack of sleep
• Increase in talking - the teen talks too much, too fast, changes topic quickly, and can't be interrupted
• Distractibility - attention moves constantly from one thing to another
• Possible loss of touch with reality
• Risky and reckless behavior such as drug or alcohol abuse, reckless driving, sexual promiscuity

During the depressive stage, the teen may experience:
• Irritability, depressed mood, persistent sadness, hopelessness, frequent crying
• Thoughts of death or suicide
• Loss of enjoyment in activities previously enjoyed
• Frequent physical complaints such as headache or stomachache
• Low energy level, fatigue, poor concentration, complaints of boredom
• Change in eating or sleeping habits

Does Bipolar Disorder occur with other disorders?

Some of the signs of Bipolar Disorder are similar to those that occur in teenagers with other problems, such as Attention Deficit Hyperactivity Disorder (ADHD), drug abuse, delinquency, or even schizophrenia. About 40% of the children with Bipolar Disorder also have ADHD. Some experts believe this is a progression of the illness; that the ADHD symptoms occur and are recognized earlier because they are behaviorally manifested. Other symptoms of Bipolar Disorder may become evident once a child has more developed language and social skills.

How is Bipolar Disorder treated?

Treatment should begin with a complete evaluation by a child and adolescent psychiatrist. Effective treatments may include:

Psychopharmacology - Mood stabilizers are effective in arresting symptoms and in decreasing the frequency and severity of future episodes.

Psychoeducation - Teaching the teen and family about the disorder and the effects and management of medication.

Psychotherapy - Cognitive-behavioral therapy, which focuses on the irrational beliefs and distorted thoughts of mania or depression, can help the youngster learn to handle stress, strengthen self-esteem, and improve relationships. Group therapy to help the teenager develop or improve social skills and/or family therapy may also be recommended.

Will a child with a Bipolar Disorder get over it?

We do not yet have a clear picture of what happens later to young children who are diagnosed with this disorder. Certainly their moods can be stabilized by medication, but we don't yet know if they will require the medication through life or will outgrow the symptoms of the disorder.

How can I parent a child with Bipolar Disorder?

Even the best parents can feel horribly inadequate when they're trying to manage a child with this disorder. These children are often demanding and cause everyone around them to worry about setting them off. Thus family members can feel as if they're walking on egg shells. Parenting these children requires specialized skills, and under the guidance of a professional, parents can be helped to understand the child's internal state and predict what situations will be most problematic. With help and support, parents of children with this disorder can learn to be super stars.